Nasopharyngeal Checkups: What You Need to Know About EBV and Cancer Risks

Q: Nasopharyngeal Checkups: What You Need to Know About EBV and Cancer Risks

Hello： Currently, the diagnosis of nasopharyngeal carcinoma is primarily based on nasopharyngoscopy and biopsy. <br>If the numbers are elevated but the nasopharyngoscopy results are normal and there are no suspicious areas requiring biopsy, you may return for a follow-up in three

Nasal and pharyngeal examination

Hello Dr.
Zheng,
About two months ago, I visited an ENT specialist at a local hospital due to yellow-green nasal discharge with blood streaks, and I was diagnosed with sinusitis.
Since there was blood present, the doctor performed a nasal endoscopy, which showed no abnormalities.
However, the doctor also ordered a Vac IgA blood test.
After taking antibiotics for about a week, my symptoms resolved.

Approximately two weeks later, I returned for a follow-up to review the results.
On that day, the doctor who performed the examination was unavailable, so I consulted the head of the ENT department at the hospital.
The report indicated a slightly elevated level of 1.49 (normal is below 0.8, 0.8-1.1 is borderline high, and above 1.1 is abnormal).
The head physician informed me that since the endoscopy showed no abnormalities, this number might indicate a past or current Epstein-Barr virus (EBV) infection.
He reassured me that this does not mean I currently have nasopharyngeal cancer, but that individuals with elevated levels may have a higher risk of developing it compared to those with normal levels.
He suggested a follow-up check in a year.
However, I was still uneasy, so the next day I sought the opinion of the original doctor who examined me.
He stated that the elevated level was concerning and recommended re-testing in three months instead of waiting a year, and if the levels remained high, a biopsy would be necessary.
I was confused because if the endoscopy showed no abnormalities, I wondered how a biopsy could be performed.
A week later, I consulted another physician who also works at a medical center.
He reviewed my nasal endoscopy and said everything looked good and that my nasal passages were clear.
He mentioned that the elevated level was not significant and that many doctors no longer consider this data in their assessments.
He explained that these tests are often conducted for patients seeking peace of mind during health check-ups and that many patients bring abnormal reports for endoscopy, which can still show normal results.
He emphasized that the diagnosis of nasopharyngeal cancer primarily relies on endoscopy and pathology results, and I should not worry about the numbers as they are not meaningful.
He also educated me on the symptoms of nasopharyngeal cancer to monitor for any issues during follow-up visits.
Later, I researched articles and physician blogs that stated this blood test is not a reliable initial diagnostic tool for nasopharyngeal cancer; it is mainly used for monitoring patients after treatment.
Therefore, having elevated levels does not significantly indicate the presence of nasopharyngeal cancer and is not accurate.
I would like to ask for your advice, as I have received very different opinions from three doctors: one said it was serious, another said the elevated number only indicates a higher probability and could normalize over time, and the third said the number is not significant and should be ignored.
This has caused me considerable distress, as I tend to be anxious and worried.
For future follow-up tests, should I continue to check the Vac IgA levels? I fear that if the endoscopy shows normal results but the numbers remain high, I will become confused and anxious again.
Currently, I do not have symptoms of nasopharyngeal cancer, such as nasal congestion, nosebleeds, or blood streaks in my morning phlegm, ear fullness, tinnitus, or headaches.
Thank you for your assistance.

A-Bao, 30~39 year old female. Ask Date: 2018/06/08

Dr. Zheng Jueyi reply Otolaryngology

Hello: Currently, the diagnosis of nasopharyngeal carcinoma is primarily based on nasopharyngoscopy and biopsy.
If the numbers are elevated but the nasopharyngoscopy results are normal and there are no suspicious areas requiring biopsy, you may return for a follow-up in three months.
If there are no abnormalities, the follow-up interval can be extended to six months to a year.
Wishing you peace and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2018/06/08

More Info

Understanding the relationship between Epstein-Barr Virus (EBV) and nasopharyngeal cancer (NPC) can be quite complex, especially when interpreting various medical tests and symptoms. It’s important to clarify a few key points regarding EBV, its testing, and the implications for cancer risk.

EBV and Nasopharyngeal Cancer
EBV is a virus that is commonly associated with several diseases, including infectious mononucleosis and certain types of cancer, particularly nasopharyngeal carcinoma. The connection between EBV and NPC is well-established, especially in certain populations, such as those in Southeast Asia. However, not everyone who tests positive for EBV will develop NPC.

Understanding EBV Antibody Tests
1. EBV IgG and IgA Antibodies:
- EBV IgG antibodies indicate past infection with the virus. A positive IgG result does not necessarily indicate current disease or cancer.

- EBV IgA antibodies, particularly the VCA IgA type, are more closely associated with NPC. Elevated levels of EBV IgA can suggest an increased risk of NPC, but they are not definitive on their own.

2. Interpreting Your Results:
- A result of 1.49 for EBV IgA, which is above the normal range, suggests that there may have been a recent infection or reactivation of the virus. However, as your doctor mentioned, this does not confirm the presence of NPC, especially if your endoscopic examination showed no abnormalities.

- The variability in interpretation among different physicians can be attributed to their clinical experience and the context of your overall health and symptoms.

Clinical Evaluation and Follow-Up
1. Endoscopic Examination:
- The endoscopic examination is a critical tool in evaluating the nasopharynx for any abnormalities. If this examination shows no signs of malignancy, it is a reassuring factor.

- If there are concerns about the results or if symptoms persist, further investigation, such as a biopsy, may be warranted, even if the initial endoscopic findings are normal.

2. Follow-Up Recommendations:
- Given the differing opinions from your doctors, it may be prudent to follow the advice of the physician who suggested a follow-up in three months, especially if you are feeling anxious about your health. Regular monitoring can help alleviate concerns and catch any potential issues early.

- If your symptoms change or worsen, or if you develop new symptoms such as persistent nasal bleeding, ear pain, or significant changes in your health, you should seek medical attention promptly.

Managing Anxiety and Health Concerns
It’s understandable to feel anxious when faced with potential health issues, especially when there are conflicting opinions. Here are some strategies to manage this anxiety:
- Educate Yourself: Understanding your condition and the implications of your test results can empower you and reduce anxiety. However, be cautious about information from non-medical sources, as it can sometimes be misleading.

- Communicate with Your Healthcare Provider: Don’t hesitate to express your concerns and ask for clarification regarding your test results and the next steps. A good doctor-patient relationship can significantly alleviate anxiety.

- Consider Counseling: If your anxiety is overwhelming, speaking with a mental health professional can provide strategies to cope with your worries.

Conclusion
In summary, while elevated EBV IgA levels can indicate a higher risk for nasopharyngeal cancer, they are not definitive on their own. The absence of abnormalities in your endoscopic examination is a positive sign. Regular follow-up and open communication with your healthcare providers are essential in managing your health and alleviating concerns. If you continue to feel anxious about your health, consider discussing your feelings with a mental health professional for additional support.

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